Antibiotics, advice on therapy

Antibiotics are essential for the treatment of infectious diseases. With their introduction, resistance to this group of drugs developed worldwide, which is now threateningly increasing. In addition to their use in human medicine, antibiotic treatments in veterinary medicine promote the development of resistance. Relevant quantities of resistance genes have also already been identified in the environment. It is assumed that around 10 million people will die in 2050 from infections with multi-resistant pathogens (O`Neil J 2016). According to Huggett S et al. the following advice on antibiotic therapy should be observed:

• Antibiotics are not antipyretics. Prescribe only if the cause is infectious. Fever without other inflammatory parameters (CRP, PCT, leukocytosis, leukopenia, left shift) is not an indication for therapy.
• A targeted therapy should be aimed for. Pathogen detection must be carried out before starting antimicrobial therapy
• Ask about allergies to antibiotics before starting antibiotic therapy
• The current resistance situation in the region or in the clinic should be asked when deciding on therapy
• Calculated (initial) antibiotic therapy until pathogen detection and resistance determination is received
• Which pathogen comes into question (wound, endocarditis, pneumonia, urinary tract infection, gynaecological infection, erysipelas, etc.)?
• Was the infection acquired inside or outside the hospital?
• Was the patient abroad?
• How long has the patient been in hospital?
• How old is the patient? Does he come from a nursing home?
• What are the wound conditions?
• What are the patient's particularities? Kidney and liver function, pregnancy.
• If possible, monotherapy should be sought.
• After receiving the determination of resistance, the initial antibiotic therapy is converted to effective substances or to preparations with a narrower spectrum.
• Simultaneous use of several nephro- or ototoxic preparations should be avoided.
• Duration of therapy: Antibiotics should be used as briefly as possible and as long as necessary. They can usually be discontinued 3 days after defibrillation.
• Early changeover from intravenous to oral application
• If the patient does not get rid of fever 2-3 days after the start of antibiotic therapy and the antibiotic detection is not successful: reconsider all the causes of the failure of the therapy. If the patient's condition permits: if necessary, discontinue ineffective therapy, take a break of several days for antibiotics, then repeat the diagnosis.

1. Huggett S et al (2018) Antibiotics Primer 2018/2019 Asclepius, Medical Scientific Publishing Company. S.VIII-IX